Aneurin Bevan, the architect of the National Health Service, would have been alarmed at the escalating blame game played out between the secretary of state for health and general practitioners last week. Bevan was no stranger to doing battle with family doctors, then and now one of the strongest professional interests in Britain. In his own words, he had to resort to stuffing their mouths with gold in order to sign them up to the establishment of the NHS.

What Bevan would have found difficult to understand, however, is why modern-day ministers seem unable to pick the right fights. Bevan's bribe was surely a price worth paying: without the support of GPs, the NHS would never been more than a proposal on paper. Fifty years later, the Labour government again went to war with GPs over performance-based contracts. At least there was a point of principle at its heart: financial concessions exchanged for what in theory should have been greater transparency and accountability, but which in practice worked out much better for surgeries than taxpayers. Ten years on, and the latest unedifying skirmish is perhaps the most pointless fight we have seen yet: an attempt to blame GPs for rising pressures on A&Es that has left the government isolated.

Health experts and political strategists alike are scratching their heads as to how Jeremy Hunt ended up engaging in a game of blame-shifting he had no chance of winning. In health, Labour has been playing some of its smartest opposition politics, calling the government out on recent breaches of the NHS target for 95% of people visiting A&E to be seen within four hours. Conservative ministers are all too aware that the NHS is one of their weakest spots and that a brewing health crisis could give Ed Miliband the next election.

But Hunt's decision to lay the blame for this squarely at the door of GPs for shunning out-of-hours provision smacks of panic. There is an immediate flaw in a member of the political class trying to engage GPs in a war of words. Just one in five members of the public trusts politicians to tell the truth; for GPs, the figure is 91%. Given this huge integrity gap, one would expect the government to avoid picking fights lightly, particularly one that is so reliant on GPs to deliver its signature healthcare reform. When respected arbiters such as the health thinktank the King's Fund quickly call the government out as wrong, ministers are in trouble.

A cocktail of complex factors lies behind recent breaches of the 95% target, but lack of out-of-hours GP provision is unlikely to be significant. Contrary to popular perception, relatively little traffic into A&Es is out of hours. Moreover, performance on the 95% target is most affected by the more complex cases coming through the door: people with more minor ailments, who could have seen their GP, can relatively quickly and easily be moved into the holding bay of a clinical decisions unit within four hours. There are a number of shorter-term and seasonal factors that have squeezed capacity in recent months: the longer and colder than average winter; higher incidence of norovirus; and cuts to social care, resulting in longer stays on wards for the elderly.

The 95% target by itself is a poor measure of quality of care; it is best viewed as an NHS pressure gauge. The alarm goes off when the target is breached. But the truth is that pressure has been building steadily over the last decade. A&E demand has risen steadily due to demographic change and medical advances: more people, predominantly elderly and frail, are surviving what were once life-threatening conditions, with complications that require more ongoing medical attention. At the same time, the number of NHS beds has gone down by a third over the last 25 years. Bed occupancy rates on wards are now often above 85%, the level above which the provision of safe care is jeopardised.

Against this backdrop, there are big challenges facing primary care, which has had to take up the slack. Primary care remains stuck in a fragmented model of provision no longer fit for purpose and there is too much variation in the quality of care. It needs to evolve into a system that blends continuity of care, so the growing number of patients with complex conditions see the same GP, with the benefits of working on a larger scale.

The answer is neither sticking with village-style GP practices, nor moving towards the medical hypermarket model of polyclinics. Instead, the government needs to prod GPs into consolidating themselves into a hub-and-spoke model, with hubs that allow the benefits of scale and specialisation, and satellite surgeries that ensure care remains grounded in the community. Surgeries also need stronger and smarter incentives to improve not just the quality of care but system management. For example, moving to telephone-first consultations with a patient's GP has been found to increase patient satisfaction, increase surgery capacity and reduce local A&E attendance by up to 20%. Yet only a tiny minority of surgeries have adopted this practice.

The government should have concentrated its political capital and reforming zeal on tackling these real challenges. Instead, it has wasted goodwill on a pointless fight and exhausted energy on a top-down reorganisation unlikely to achieve anything other than distracting managers and clinicians from what really counts: improving the quality and efficiency of care.

This is a theme echoed across government. Over an education, Michael Gove has chosen to pick fights with teachers over the detail of the history curriculum rather than making it easier to sack poor teachers, and undertake a structural reform on the basis of ideology rather than evidence. It is not a uniquely Conservative problem. Tony Blair rolled back GP fundholding only to reintroduce it a few years later. Ed Miliband's Labour has yet to set out how it would make the necessary but difficult trade-offs to achieve more for less in health.

The politics of responsible, long-term public service reform is toxic: closing wards and hospitals to invest in better acute and community care; letting class sizes creep up to invest in the quality of teaching. Bevan once said he regarded politics as the arena of interest, not morals. But if he had allowed interests to rule over what was right, we would have been left with a messy, highly fragmented system of hospital care today.

As the NHS moves into its seventh decade, the complications it faces are greater than ever. It desperately needs a political version of the continuity of care that ministers expect from our GPs. To protect Bevan's legacy, we need a visionary willing to put the national interest above party politics. The questions is: are our politicians equal to the task?